Gilbody et al (Reference Gilbody, House and Sheldon2002) highlight the poor adherence of psychiatrists to using instruments to measure clinical outcomes. Assessment tools and outcome measures have been in use among practitioners working with people with learning disability for many years. There are many validated tools and reliable measures available for use in clinical practice that are routinely used. The take-up of assessment tools and outcome measurements has perhaps been influenced by the proportion of this patient group who have poor verbal skills, making access to their mental state and internal world a challenge to the clinician.

Observation of behaviour is an important element of assessment of mental health problems in people with learning disabilities. The Mini Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS—ADD) is commonly used to detect psychopathology in people presenting with challenging behaviour that may be due to mental illness. It has been shown to have good reliability and validity (Reference Prosser, Moss and CostelloProsseret al, 1998). The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS—LD) is a useful tool to measure change over time to a therapeutic intervention (Reference Roy, Matthews and CliffordRoy et al, 2002). Clinical observations can be carried out by any clinician in the multi-disciplinary team trained in the application of these clinical tools.

It could be argued that the use of these instruments is reductionist and does not communicate the breadth of human experience and suffering of patients. Where language fails to express the impact of mental illness and social distress, I would hold that the use of rating scales can objectively indicate the nature of the suffering and the effectiveness of interventions made in patient care.

I believe the key to the use of tools in the future will depend on educating trainees to use these instruments and allowing them to be freely available in clinical practice. Of course they would gain greater prominence in practice were they to form part of assessment in the MRCPsych examinations!